NICE updates prescribing guidelines for common infections

The National Institute for Health and Care Excellence and Public Health England have published updated antimicrobial prescribing guidance for managing common infections.

Conditions covered within the guidance include blepharitis, herpes zoster/varicella zoster, infected eczema, chlamydia, conjunctivitis and cellulitis.

The refreshed guidance on managing blepharitis, which was last updated in 2017, advises using lid hygiene measures as a first line treatment, including warm compresses, lid massage and scrubs, gentle washing, and avoiding cosmetics.

Topical antibiotics are recommended as a second line treatment for the condition if initial measures are ineffective after two weeks, while clinicians are advised to consider oral antibiotics if there are signs of meibomian gland dysfunction or acne rosacea.

Guidance on the management of conjunctivitis was last updated in November 2019. The new guidance recommends cleaning the eyelids with cotton wool dipped in saline or sterile (boiled) water to remove crusting as a first line treatment.

Clinicians are advised to treat conjunctivitis only if severe as most cases are viral or self-limiting.

For bacterial conjunctivitis, chloramphenicol 0.5% eye drops or 1% ointment is recommended as a second line treatment. Fusidic acid 1% gel is advised as a third line treatment.

Refreshed guidance on cellulitis highlights that infection around the eyes or nose is more concerning because of the potential for serious intracranial complications.

Clinicians are advised to consider marking the extent of the infection with a single-use surgical marker pen.

Flucloxacillin is recommended as the first choice of antibiotic for cellulitis, but if the infection is near the eyes or nose then co-amoxiclav is advised.